Here we go roundabout with the credentialing discussion – again.
I realized during the discussion on the Plexus social networking article that the article is approved for continuing education credits (CECs) for those who are credentialed CMTs. In my opinion, this takes the discussion to a completely new level.
First, indulge me while I talk (again!) about the credential itself.
In another comment in the Mandatory Credentialing entry, Lea says:
Credentialing is about moving the profession forward, not the individual.
This comment reminds me of a time when my children were in elementary school here in the Los Angeles Unified School District and I was involved in the parents' group for the school. At that time, the big fundraising goal was enough money to install air conditioning. Unfortunately, because of inadequate electrical wiring added to the cost of the actual A/C system, it was a daunting task. So much money was required to install A/C for even a few classrooms, few (if any) of the parents would still have children at the school by the time there was enough money. It's next to impossible to convince people to donate time and money for something that will not reap them (or their children) any benefit.
The same is true in MT. One reason the CMT hasn't been widely embraced is the fact that it holds little value for the practitioner MT. Head down, trying to grind out lines and scraping for work, trying to pay the bills, the average MT has little interest in advancing the profession. It's an obscure and remote purpose with no immediate benefit. AAMT/AHDI has been telling the MT community for years that we should all be concerned about advancing the profession and that joining the organization and being involved is how we do this, getting credentialed is how we do this. For years, AAMT/AHDI has had difficulty communicating its purpose in a way that resonates with practitioner MTs and the CMT is no exception. Over and over and over, MTs hear the same mantra from AHDI leadership and CMT supporters.
Giving credit where it's due – and because she feels I've been beating up on her here – Lea Sims wrote a good article on how we got to this point at the AHDI Lounge: Let's Talk Wages. I think the article is a good start on the discussion, but I'm going to disagree with some of the assessments and conclusions (what a surprise, eh?!). For AHDI, the answer is always get more involved in the association, get credentialed. The article discusses Blue Ocean stratagies; the problem is, apparently it relied on the Wikipedia explanation and not the book. Because in the book, there is a discussion about barriers to imitation that are required for Blue Ocean Strategy to work – otherwise, even if you find or create your “Blue Ocean,” the sharks move in and you're back in a bloodbath. For the Blue Ocean strategy to work, it needs to go without challenge for 10 to 15 years. In the medical transcription world, there have been no barriers to imitation and attempts to differentiate were quickly imitated. In fact, the very innovation that was meant to differentiate was picked up by SaaS (software as a service) vendors, who turned around the differentiating characteristic and made it available to anyone for a fee. In Blue Ocean terminology, once again the chum was thrown in the water and the sharks circled. The truly negative effect this had – along with HIPAA legislation – was to start working against smaller transcription services, who struggled with the cost of technology and the cost of compliance with HIPAA. The cost of entry for many of the SaaS platforms was prohibitive – $10,000 and up per account, more for speech technology, with minimum line requirements (understandable because of the costs associated with ramping up SRT) – and what had begun as a differentiation strategy became just another commodity, a requirement of doing business, not an added value to the service.
But the biggest problem underlying all of this is not just the commoditization of medical transcription – it's the commoditization of healthcare in general, rising costs and reduced reimbursements, coupled with the push for electronic records. There simply isn't any evidence that credentialing would monetarily benefit the MT work force in an environment where there are increasing cost constraints and a huge push towards eliminating or significantly reducing the need for manual transcription. I realize AHDI has to remain positive about the outlook for medical transcription in an electronic record environment, but I don't feel the need to put on rosy-colored glasses, so I'll say what they can't – I'm not optimistic about it. I don't think there's going to be a blue ocean any time in the future of the industry. I think a lot of people are going to drown if they don't start thinking about an exit strategy. And let's face it – who is going to come out ahead in the competition for business in an electronic record environment? Again – the large companies that have the money to put into the technology.
So, after evaluating the industry as a whole, and the place of transcription in it, I'll move on to the value of credentialing. We've all heard Albert Einstein's famous quote: “The definition of insanity is doing the same thing over and over again and expecting different results.” For years, AHDI leadership has stated over and over and over again, that if enough people get credentialed or credentialing is mandatory, perceived value will increase and wages will increase. Even if we believe this to be true, the problem is getting everyone in the supply chain not only to believe it to be true (see the paragraphs above), but to “buy in” for that long haul. And AHDI has never seemed to understand that in order to get people to buy in for the long haul, there have to be immediate benefits that carry through. There's only so much people are going to be willing to sacrifice to promote the profession when they not only don't see any benefit after years of being credentialed, but they see no benefit from the organization that supports the credential.
And if AHDI sounds like a broken record on this point, I feel like I'm a broken record as well. I've said it in other posts here – for MTs to see a benefit from credentialing, the employers have to start preferring or requiring it. If there was actually preferential hiring of CMTs, more MTs would get the credential. But the employers need to see a benefit, as well. And part of that benefit is that CMTs are more qualified than non-credentialed MTs and/or that there is a benefit to the client that creates sufficient differentiation that the service can either obtain the contract over an outsourced service whose workers aren't credentialed or that they are able to charge more for the service, thus offsetting the cost of preferential hiring and pay incentives for the credentialed MTs. In my opinion, the commoditization of medical transcription has progressed beyond the point of no return. Healthcare industry factors simply aren't conducive to any scenario that increases the cost of labor for transcription. Hospitals aren't making money – they're operating at deficits that run into millions of dollars per year.
But let's suppose for a minute that we believe credentialing adds sufficient value to accomplish the stated goals of increased recognization, reversal of commoditization and increased pay. I'm going to ignore the RMT credential – it's an entry-level credential. If we're talking about a CMT credential that has sufficient meaning to gain preferential hiring and pay incentives, then as an employer, I'd want to believe that those people are worth it; i.e., the best of the best. I want to know that the continuing education they get adds to their knowledge base and skill level.
All this discussion leads me back to the Plexus social networking article and the fact that it was deemed worthy of CECs.
Let's look at the AHDI web site and the requirements for qualifying for getting an article, presentation, webinar, etc. approved for CECs:
Let me emphasize a few points here and how they relate to the comments made in the other entry…
“… must be formally presented by qualified professionals…”
That leaves open a pretty wide door – qualified in what? I would hope that means qualified in some way to speak on the topic being presented, yet that doesn't seem to be the case here. A gastroenterologist is a qualified professional but probably wouldn't be the best person to write an article on plastic surgery, no matter how well researched it was. Anyone who really wants to support the credentialing process should be confident that the qualified professional is, indeed, qualified in the subject matter being presented. Otherwise, Nae Priest (no offense, Nae!) could have written this article and been deemed a qualified professional. And I'm pretty sure she'll admit she's not qualified to write an article on social networking!
There are all kinds of articles, including invesigative and research pieces written by staff writers who are not “authorities” on their subject matter – they are simply reporting what they have researched. If there was a standard suggesting that in order to write about something in public media you had to be an authority on it, very little writing would get done by an one.
While I agree with that statement, not all articles are approved for CECs, either. Yet – this article was. I can think of at least one communications director for a major healthcare organization who offers a free tutorial on effective use of Facebook for both personal and business use and how to keep the two separate. And since he has spent the time to do that, as well as the time to engage in telephone conversations with me about it, I'm pretty confident that he would allow use of some of his materials for free and he might even be willing to write an article for the publication that was more authoritative and helpful. How did I connect with him? Social networking. Even within the AHDI membership network, there are qualified professionals with experience in social networking – the Keystrokes Transcription Service group on Facebook has almost as many members as the OA-AHDI, which would also have been a good resource for laying this foundation.
The requirements also indicate:
“Articles, presentations and workshops directed to lay audiences or the general public are generally not creditworthy.
This particular article earned CMTs one credit towards the “MT Tools” (4 total credits required in a 3-year recredentialing period).
By a really loose interpretation of the above, it's possible that the basics of social networking might fall under “MT resources and references.” I say loose because the article was so general – it made no mention of MT groups on MySpace, Facebook, LinkedIn or anywhere else, or how they might be utilized to better connect with other MTs. At best, it could be described as being directed towards lay audiences. There was nothing in it that was directed towards medical transcription in particular. There are no specific healthcare documentation resources listed. It could have been in any publication.
According to Lea Sims:
The value of a social networking article for MTs (and why it was assigned credit) was simply to help the at-home, isolated MT who may be clueless about social networking get a little more comfortable with it.
OK – I get that. But I'm still critical of why this was approved for CECs. Members at AHDI may have been interested in knowing more about social networks – I'm sure there are a lot of things AHDI members are interested in, but that doesn't automatically translate into a responsibility by the association to fill the void and give CECs for it. I'm not seeing the leap of logic that indicates telling them more in a very generalized way falls in the category of “MT Tools.” Actually bringing in the MT resources in social networking instead of making the article very general would, in my opinion, have moved the article from one directed towards laymen to one that was actually about MT resources in the social networks. If the organization feels its members aren't ready for such specific information, that's understandable – but don't give CECs for teaching them how to crawl, for heaven's sake! One would hope that the CMT credential is for people who are running, not crawling, and that the continuing education actually enhances their MT abilities.
I am sure the argument could be made that it's just one CEC among many. The problem is that once a credibility gap occurs, we all start wondering what other flaws exist in the system. The CMT already has credibility issues. Fluff CECs that could best be described as “Social networking for Beginners” add little to the credential that's supposed to be the hallmark of excellence. Most employers would consider social networking for their MTs to be a personal thing, best engaged in during off hours. Nobody wants their MTs spending time in the social networks when they should be working. What, specifically, is there in the social networks that makes my MTs better MTs, able to do their work more accurately or faster? And why should I pay them more to learn how to be more sociable online? To put not too fine a point on it, employers may not really care that their MTs are socially isolated – in fact, they'd probably point out that many people become MTs because they prefer to be isolated.
Maybe I could get some of my blog entries approved for CECs.